Not by Food Alone: Ensuring Nutritional Security through Agricultural Research, Education and Extension

We all know the old saying that “Man does not live by bread alone”. Perhaps in keeping with the times, and what we have heard at this Congress, today we would say: that human beings need food to survive, but food alone is not enough for people to thrive – and to live a healthy, productive and dignified life.

We at the South Asia Food and Nutrition Security Initiative (SAFANSI) believe that the challenge of hunger and malnutrition in South Asia, as elsewhere, requires a multi-pronged approach, including: greater availability of food; enhanced livelihoods; education; clean water and sanitation; women’s empowerment; social protection; and a special focus on infant and child care.

But above all else, genuine food and nutrition security requires a political commitment that recognizes hunger and malnutrition as violation of people’s human rights, as well as a serious impediment to national development.

The importance of political commitment was graphically highlighted by the Nobel Laureate Amartya Sen who famously argued that the Great Bengal Famine of 1943 was not caused by shortage of food, as the granaries of Kolkata were apparently quite full, but the British Raj of the time felt no political obligation to protect the starving masses from famine.

As we know, Amartya Sen also propounds a thesis that there is no large-scale famine in a functioning democracy.

Well, democracy may indeed help avert visible famines, but as we have seen here in India, in South Asia and other parts of the world, democracy is not an adequate anti-dote to combat malnutrition, which is often invisible to the naked eye, and therefore cannot be sensationalized in election campaigns.

Conventional wisdom would have it that hunger and malnutrition result from a lack of food or an unbalanced diet. But we know that hunger has many dimensions. There are at least four types of hunger:

The first hunger is the most obvious, caused by lack of food. When we speak about millions of people going to bed hungry, or when we see the heart-wrenching pictures of emaciated children dying in famines, that is the common kind of hunger we refer to.

The second hunger, which we have not talked about much at this Congress, is the “hidden hunger” for micronutrients – the minerals and vitamins such as iodine, iron, and vitamin A. This type of hunger does not manifest itself in the form of a bloated belly or emaciated body. But it strikes at the core of people’s health and vitality. It seriously damages human brain, learning ability, human health, and productivity.

The third type of hunger is the need of children and women for adequate care, nurturing, and protection from infections, without which food alone cannot protect them from malnutrition.

The fourth hunger is for safe water, clean air, and a sanitary environment – so essential for promoting health, growth and nutrition, as well as liberating women from the drudgery of these time-consuming chores.

To these, we might add the growing occurrence of obesity, largely caused by junk foods and unhealthy life-styles, which is becoming an alarming phenomenon alongside under-nutrition, even in very poor countries and communities.

Indeed, it has been noted that both under-nutrition and obesity are a reflection of the life-cycle consequences of inadequate foetal and infant growth, and the life-style related consequences of urbanization where the poorer people, including children, often eat cheap, processed foods which fill the belly and satisfy their taste buds, but harm their health.

Interestingly, some of the solutions to under-nutrition and over-nutrition are common. Optimum breastfeeding, for example, prevents both under-nutrition as well as providing protection from some obesity-related diseases.

Overcoming these different types of hungers, requires a holistic, life-cycle approach to ensure that all children get a healthy start in life; that all families have essential household food security; that primary health care and basic education are universally available in all communities; and that we promote good nutrition and healthy lifestyles among adolescents and adults.

Learned nutritionists tend to be a cantankerous lot. For far too long, they have debated about the intricacies of various nutrients and enzymes, and failed to persuade politicians and policy makers with simple and persuasive messages as to why investing in nutrition is one of the best bargains to promote national development.

We all say that nutrition requires a multi-sectoral approach, which it does. But therein lies a big problem. When something is multi-sectoral, it becomes nobody’s priority. Most sectoral ministries of governments understandably champion their own sectors. And multi-sectoral programmes become secondary and discretionary for which one can always pass the buck to another ministry.

And there are very few Planning Commissions and Finance Ministries, or the Chief Ministers’ or Prime Minister’s offices – with a few notable exceptions like our honourable Chief Guest and the current Prime Minister of India – that undertake an enlightened leadership role in support of programmes that maybe very important, but for which there is no lobbying by powerful constituencies.

And so it is that nutrition has become a subject that is over-studied and under-acted upon.

Now, fortunately, there has been a significant change in the last decade – and a growing consensus nationally and internationally – on what needs to be done to improve nutrition; why it deserves a high priority; and some very strong evidence-based cases for investing in nutrition.

About a decade ago, the World Bank issued a seminal report on “Repositioning Nutrition as Central to Development”, drawing on evidence from many country studies that demonstrated very high cost-effectiveness of many nutrition interventions.

In 2008, the British medical journal, The Lancet, published a series of articles, again drawing on lessons learned from many projects around the world, and made the case that there was a golden 1000 days’ “window of opportunity” from pregnancy to two years of age, during which a set of specific nutrition interventions have the greatest impact in dramatically reducing malnutrition, morbidity and mortality in children, and greatly enhancing their learning and earning ability as they grow up to adolescence and adulthood.

Around the same time, a group of leading economists, including several Nobel Laureates, came up with what came to be known as the “Copenhagen Consensus” that showed that investment in nutrition, such as on micronutrients and some community-based nutrition interventions had far higher rates of economic return and social impact than investment in any other sector.

All of this culminated into a bold proposal for “Scaling Up Nutrition” – The SUN Initiative -around which there is now an emerging global consensus among governments, UN agencies, multilateral and bilateral organizations, academics and NGOs that are key players in promoting nutrition.

The SUN Initiative recommends two complimentary approaches to reducing under-nutrition – a set of about a dozen specific and evidence-based direct interventions to prevent and treat under-nutrition, and a broader multi-sectoral approach to deal with the underlying causes of malnutrition.

We do not have the time this evening to elaborate these interventions, which most of you already know, and others can access at: www.scalingupnutrition.org .

The South Asia Food and Nutrition Security Initiative (SAFANSI) was partly inspired by the SUN Initiative. By the way, SAFANSI is a World Bank-managed Trust Fund, supported by UKAid (DFID) and AusAid, which seeks to build alliances across borders among SAARC countries, and across various sectors to connect analysis, advocacy and action among implementers, policy makers and civil society players to promote food and nutrition security.

SAFANSI was also partly inspired by what came to be known as the “Asian Enigma”, a term coined in the mid-1990s that referred to the puzzle of why despite the “Green Revolution” and rapid economic growth, South Asian countries had double the rate of malnutrition than sub-Saharan Africa.

As a South Asian who happened to be Director of Programmes at UNICEF HQ in the 1990s, I wanted to better understand this enigma. So we got UNICEF to commission three leading experts on health and nutrition with deep experience in Asia and Africa, the late Dr. Vulmiri Ramalingaswamy, Urban Jonsson, and Jon Rohde to elucidate the causes and consequences of this reality. What they reported then in 1995 was intriguing and fascinating, and is still valid today.

First, they examined, and ruled out, the ‘usual suspects’ for potential causes of malnutrition in South Asia – concluding that it was not really the high level of poverty, or the vegetarian diet, or poor agricultural performance that was the main culprit, because in those respects most African countries were worse off than Asians.

Instead they concluded that the lower status and greater neglect of girls and women, and the poorer hygiene and sanitation in South Asia which had higher level of urbanization than Africa, were more critical factors. These led to the inter-generational transmission of malnutrition through low-birth weight, inadequate breastfeeding, poorer health and nutrition of adolescent girls and pregnant women, all of which made Asian children more vulnerable to infection and malnutrition.

Even today, there are several “Puzzle States” in India, such as Gujarat, Kerala and Punjab where, despite high agricultural growth and high literacy rates, very high rates of malnutrition persist. At the household level, adequate income does not seem to guarantee adequate nutrition; as even among the richest quintile in India, 64% of preschool children are iron deficient and 26% are underweight.

Similar stories can be cited from other South Asian countries. This knowledge is now leading to action.

My home country, Nepal, has recognized this reality and recently came up with an ambitious multi-sectoral food and nutrition security plan. I know that there are similar initiatives afoot in other countries of the region, and several states of India, including here in our host state of Odisha.

Here, let me take the occasion to warmly congratulate Honourable Chief Minister Navin Patnaik who has provided strong leadership to turn Odisha from being one of the laggard states in India in terms of nutrition, and has transformed it into one of the better performing states where most indicators of malnutrition have improved quite significantly in the last decade.

Odisha’s malnutrition rates are now closer to India’s national average – thus, there is still a long way to go – but the Chief Minister’s personal attention, enlightened leadership and consistent policies show how strong political commitment and leadership can help turn around the situation dramatically.

So, based on this diagnosis of the problems, and lessons learned, what do we do next, and in particular how can those of us involved in agricultural research, education and extension be helpful?

I believe that several decades of experience, trial and errors, and lessons learned from the best practices in India, South Asia and other countries in the world that have made better progress than we have point to the need for us to follow a two-pronged approach.

First, let us scale up certain proven interventions such as: breastfeeding, complementary feeding, improved hygiene practices, including hand-washing. Let us ensure provision of micronutrients for young children and their mothers, including Vitamin A and zinc supplements, deworming, iron-folic acid supplements, ensuring therapeutic feeding and treatment of malnourished children with special foods, and a massive effort for salt iodization and iron fortification of staple foods.

I believe that the MS Swaminathan Research Foundation’s “Malnutrition-Free Odisha Program” emphasizing bio-fortification as a “horticultural remedy for nutritional malady” offers a good example to emulate.

Ensuring food and nutrition security is clearly one of the central challenges of human development in India and all over South Asia. Our countries will fail to achieve or sustain most of the MDGs if we cannot ensure a minimum of food and nutrition security. I would, therefore, hope that the eminent agriculture and extension experts at this conference, and centres of excellence such as the Orissa University of Agriculture and Technology, can make a major contribution through applied research and especially human resource development in this area.

Secondly, recognizing the multi-sectoral nature of nutrition, let us work on such underlying social determinants of nutrition, and malnutrition, including girls’ education and women’s empowerment, improved gender equality and social protection; and universal access to clean water and safe sanitation.

In this context, some of India’s great efforts through improved coverage of ICDS centres and anganwadis, the Total Sanitation Campaign, the National Rural Health Mission, and the more successful State-level Nutrition Missions are highly promising, and need to be further strengthened and expanded.

Nutrition must be made everybody’s business. Thus India’s judicial activism and civil society’s campaign for the right to food and nutrition are welcome initiatives. The Citizens’ Alliance against Malnutrition that brings together parliamentarians and journalists, movie actors and musicians, celebrities whose voices can create a HUNGaMA, are needed to accelerate progress.

Strong political commitment and leadership to ensure greater inter-ministerial coordination, such as through the Chief Minister’s Nutrition Council here in Odisha, and the personal involvement of the Chief Minister, and nationally, the Prime Minister, in periodically monitoring progress in combating malnutrition can make a decisive impact.

Dear friends,

The world produces enough food to feed every man, woman and child on earth. Hunger and malnutrition are therefore not due to lack of food alone, but are mainly a consequence of poverty, inequality and misplaced priorities.

Let us use our collective energy and innovative genius to overcome this shameful blemish on our region, South Asia, as the epicenter of the world’s worst malnutrition. Let us make this ancient land of great civilizations, rich culture and natural beauty, a land free of hunger and malnutrition as it emerges as the new economic power-house of the 21st century.